Chronic Disease

Heart failure is the most frequent reason for hospital admission and mortality in Medicare beneficiaries, costing $10.7 billion just for inpatient care alone each year. Neither market competition levels nor better adherence to most heart failure performance measures provided by the Joint Commission lowered mortality rates, according to a new study. However, careful attention to the Joint Commission’s discharge instructions and assessment of patients’ left ventricular function did lower mortality rates in an incremental manner for hospitals with the highest mortality rates.

The researchers analyzed data from 3,011 hospitals participating in the Joint Commission program on standardized heart failure performance measures. These four measures consist of prescribing specific heart failure medications at discharge, discharge instructions, smoking cessation counseling, and evaluation of left ventricular (LV) systolic function. They also rated each hospital on its level of market competition.

The average annual number of heart failure cases per year was 451,536. Mortality rates were .01 at 7 days, .06 at 30 days, .14 at 90 days, and .32 at 1 year. Hospitals varied widely in their performance on the measures.

In an unadjusted analysis, higher levels of adherence to LV function assessment resulted in a 1.6 percent lower mortality at 1 year. Smoking cessation counseling produced a 0.8 percent lower mortality. When the researchers adjusted for market competition intensity and other hospital, patient, and market characteristics, only the discharge instructions measure significantly reduced mortality. Even just a 1 percent increase in this measure resulted in a 0.2 percent lower mortality at 7 days. In hospitals with the highest mortality rates, greater adherence to discharge instructions and LV function assessment resulted in greater improvements in patient outcomes. The study was supported by AHRQ (HS17944).